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The Public Health Service has requested that the latest recommended treatment schedules for gonorrhea be widely distributed among physicians, since the incidence of the disease appears to be increasing sharply.—Ed.Physicians are cautioned to use no less than the recommended dosages of antibiotics. UNCOMPLICATED GONOCOCCAL INFECTIONS IN MEN AND WOMEN DRUG REGIMEN OF CHOICE The regimen of choice is aqueous procaine penicillin G, administered at a dose of 4.8 million units intramuscularly, divided into at least two doses and injected at different sites at one visit, together with 1 gm of probenecid, by mouth, just before the injections. ALTERNATIVE REGIMENS Patients in whom oral therapy is preferred should take ampicillin, 3.5 gm, by mouth, together with 1 gm probenecid by mouth, administered at the same time. There is evidence that this regimen may be slightly less effective than the recommended treatment with aqueous procaine penicillin G.Patients who

In summary, tremendous advances have been made over the past 15 years toward the development of effective national immunization programs throughout the world. Immunization levels among children in the developing world have risen dramatically, and in some instances, now equal or exceed levels in industrialized nations. There is no room for complacency, however, because millions of children remain incompletely immunized and many die each year from measles, pertussis, and neonatal tetanus. Immunization activities need to be intensified, accelerated, and sustained within the context of the primary health care system. Expansion of immunization programs to include additional vaccines and other simple health interventions will yield further benefits in the years ahead.

In the developing world, excluding China, <40% of infants receive a third dose of diphtheria-tetanus-pertussis or poliovirus vaccines. More than 3 million children still die annually from measles, neonatal tetanus, and pertussis, while more than a quarter of a million children are crippled by poliomyelitis. Acceleration of existing efforts, with the use of approaches that must differ according to the requirements of individual countries, constitutes the overriding priority for the Expanded Programme on Immunization (EPI). In evaluating immunization programs, priority should be placed on monitoring immunization coverage and disease incidence. Routine reports are essential for this purpose, although they may usefully be supplemented by surveys. The problems revealed by an evaluation of immunization programs can be taken as being generic to the health services as a whole, until proven otherwise. Therefore, in remedying these problems, approaches that improve the health services as a whole should be sought.

In the developing world today, <20% of children are immunized against diphtheria, pertussis, tetanus, tuberculosis, measles, and poliomyelitis. Consequently, these diseases kill 10 children and disable 10more each minute. To address this problem, the World Health Organization created the Expanded Programme on Immunization (EPI), with the goal of reducing morbidity and mortality by making immunization services available for all children of the world by 1990. This goal will be difficult to achieve. Information systems and immunization services themselves need to be strengthened. This goal will require commitments by the developing countries of human resources and commitments by developing and developed countries of financial support. Commitment is also needed by parents, who need to be informed that death and disability from these diseases can disappear if their children are immunized. Can these commitments be obtained? There is no choice but to try, for few appeals can be made as powerfully. The EPI cannot be permitted to fail.

In 1977 the 30th World Health Assembly affirmed that the main social target of governments and the World Health Organization in the coming decades should be “the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life.” The International Conference on Primary Health Care in Alma-Ata, USSR in 1978 identified primary health care as the fundamental approach for attaining this social target. What relevance do these pronouncements have concerning the worldwide control of measles? Is primary health care a prerequisite to control? Is it sufficient? It is concluded that little chance for global measles control exists unless national policy makers and health workers at all levels adopt the general approach of primary health care but that it is unlikely this approach, by itself, will assure measles control. Special efforts to reduce or stop measles transmission will also be required. In most developing countries at least, the goal of measles control can best be pursued as part of a broader program to reduce morbidity and mortality from several diseases of children preventable by immunization.